Middlesex Hospital terminating contract with Anthem

A letter sent today to Ct Attorney General Richard Blumenthal from Barbara Day:

Today, in the mail, I received a letter from Anthem Blue Cross and Blue Shield, dated March 30, stating "Middlesex Hospital has terminated its participating hospital contract with Anthem.

If we are unable to reach agreement on its renewal, then effective May 1, 2009, Middlesex Hospital will no longer be a participating hospital in Anthem's networks".

Is it legal to give Anthem members only 30 days notice of a termination of this magnitude? I'm sure this effects thousands of private citizens, corporations, school districts, physicians and untold others in Middlesex county and surrounding areas.

If this termination comes to fruition, it will impact many thousands of people who will be forced not only to travel to Hartford or New Haven for hospital care, but will be driven to find new doctors associated with hospitals in those areas. This has the potential of becoming a problem of gargantuan proportions.

I, personally, resent being used as a pawn between two large entities and the angst it has created in my life.

My fervent hope is that the State of Connecticut can and will mediate this situation.

Barbara H. Day

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19 Comments

Unfortunately, this is a game played all too often by the larger insurance companies. They have such a monopoly that it is difficult for hospitals and providers to have any leverage in contract negotiations. Kudos for Middlesex for standing up to them. The sad thing is that the insurance companies typically win, and the patients/policyholders are not part of the equation.

I hope that they can reach an agreement, this is really a surprise for me considering all of Middlesex Hospital employee's are covered by BCBS. 30 days isn't enough to find other doctors with the experience my family requires. But I did notice the way BCBS put it- "Middlesex Hospital has terminated its participating hospital contract with Anthem". I read the hospitals notice, it is much more diplomatic. "To date, Middlesex Hospital has been unable to reach an agreement on a managed care contract with Anthem Blue Cross and Blue Shield. The Hospital is working very hard to reach a positive agreement, but if this is not possible, Anthem Blue Cross and Blue Shield may choose not to reimburse Middlesex Hospital as a participating provider as of May 1, 2009" Everyone knows that it is difficult to get reimbursements back from insurance companies, approval, perscriptions, etc... and all of a sudden the hospital terminates? hmmm, more like the hospital wouldn't give in to drastic cuts. By far Middlesex Hosp is the cleaniest hosp I have been in. The doctors are decent, respectful, and give you treatment and tests as are required. Why would I go someplace else?

It is also a game played by too many hospitals, reality is many hospitals feel they should be paid more than other hospitals for providing equal and sometimes lesser care than their equivelents in the same regions. Malpractice Insurance, building expenses, are all going up. Both sides need to figure out how to do more with less. Without patients/members neither side would be in business.

Quite honestly Kb, not only should the hospitals and insurance companies duke it out- and one way is to stop paying the crap that floats at the top parts of both administrations so much: management is quite over rated - and do more with less; But also, the consumers should stop smoking, stop drinking, eat less, take up some excersize, stop having more kids than they can afford, stop buying cars, clothes, houses, furniture, etc than they can not afford. WE ALL have to figure out how to "do more with less". "WE", as a society, need to stop being so damned entitled.

Here's the way I see it: All of my doctors are affiliated with Middlesex Hospital, as is the closest emergency clinic to my home. My family has received higher quality services from Middlesex Hospital and its affiliates than from any other hospital we have used. Changing healthcare providers would be a royal pain. On the other hand, the state of CT open enrollment period closely coincides with the Middlesex Hospital/Anthem contract renewal/termination date. I'm sure I'm not the only state employee in this area who would prefer to switch insurance companies rather than switch healthcare providers.

All the insurance companies are interested in paying out as little of the money they collect in premiums as possible. This margin (read: profit) needs to be balanced so they don't lose too many customers or hospital contracts. They play their games while the people they cover have to drive an extra 30 miles to get medical care.

WAIT A MINUTE. ARE YOU TELLING ME IF I HAD ANTHEM BCBS AND LIVED IN THE MIDDLETOWN AREA AND NEEDED TO HAVE SURGERY OR SOME OTHER MEDICAL CARE I COULDN'T USE MY INSURANCE THAT I PAY FOR AT THIS HOSPITAL OR EVEN PERHAPS ANOTHER HOSPITAL BECAUSE A HOSPITAL TERMINATED THEIR CONTRACT WITH ANTHEM BCBS ?
I UNDERSTAND BIG WIGGED INSURANCE COMPANIES CONTROL THE WORLD AND WE SHOULD BEWARE AS BUYERS BUT IF IT'S MY INSURANCE THAT I BUY I DON'T GET IT.
CAN SOMEONE EXPLAIN?

Maybe I'm being Pollyanna, but this letter smells like a huge power play to me. Things will work out before the deadline because the letter is going to have phones ringing off the hook at Anthem on Monday morning. Not that they will answer them ...

I received this notice from BC/BS this weekend also, and I would also like to know if it's even legal for Anthem to only give 30 days notice of the termination. I am now 32 weeks pregnant, and my doctor that I have been receiving care from for my entire pregnancy thus far is affiliated with Middlesex Hospital. It goes without saying that it is unreasonable to notify a patient with such short notice that they will be required to go to a different hospital. I have become familiar and comfortable with the doctor that I currently see, and it is unreasonable that at this far into my pregnancy, and after months of having the understanding that I would deliver at Middlesex, I will be forced to make other arrangements. With the delivery of a child, or ANY major medical procedure for that matter, it is in the patient’s best interest that they are treated by a physician that they are well acquainted and comfortable with. I am sure that there are many other people with cases similar to mine, and I am hopeful that this situation will be resolved so that patients may continue to receive quality health care without the inconveniences of switching doctors or driving further to “in-network” hospitals.

I have asked our insurance brokers to prepare a quote for us to switch from Anthem.

This issue highlights the problems with our whole health care system. I read an article from the Courant archives that lambasted Middlesex Hospital for paying Robert Kiley the highest salary for any hospital administrator in the State (an unconscionable $1.9 million). On the other hand insurance companies including the non-profits are sucking the life out of our economy, by literally stealing from the rest of us. Their business plan is to provide less value than what they take in.

I've seen a show on CPTV that studied the results of other delivery models around the world - and it seems like we could copy from practically anyone else and be much better off.

Yes, it's your insurance, but not every doctor or every hospital has an agreement with Anthem to accept their patients and their payment. Hospitals have contracts with insurance companies that agree on how much will be paid for each type of service. These contracts get re-negotiated over the years. There is nothing to force a hospital to accept an insurance payment that is less than the cost of providing that service, with the exception of Medicare, Medicaid, and Husky (in CT), where the hospitals lose money on most services they provide.

Under socialized medicine, ALL payments will be money-losers for hospitals... and what will they do then? How can they invest in new equipment, specialists, or education? At current government payment rates, all they'll be able to do then is cut services, quality, and access.

This story of BCBS being at odds with the Middlesex Hospital is causing much anxiety for many of us. It appears that the only thing in mind here is the almighty dollar. Has no one any concerns for the patients and the local doctors who do such a wonderful job. Perhaps both sides of this issue could do some belt tightening like most of us have to do lately to survive. Asking us to get new health insurance and new health care providers is rediculis. Where are the doctors in this area going to go for new patients when we will be forced out of their practices because of greed on the part of the insurance company and YES the hospital heads. Mr. Kiley could take a cut in salary for the good of the community don't you think! He has a beautiful facility in Middletown that serves thousands of people every year and who count on this facility for life and death problems. Please resolve the differences between the insurance provider and the health care facility so both patients and doctors and do their jobs in the Middlesex community.

I am 6 1/2 months pregnant and was supposed to be delivering at Middlesex Hospital in July. I have Anthem as my insurance provider. I am forced (6 months into the pregnancy) to possibly find a NEW doctor and a NEW hospital in which to deliver my baby! I have been on the phone with the doctor's office, Blue Cross and Middlesex Hospital and no one is ABLE TO TELL ME ANYTHING!!!!!! This is the most frustrating thing that has ever happened to me!

I can't beleive with the amount of money we pay every week for BCBS that they can't pay the hospitals what they deserve? Even with my employer paying 50% I have to cut back on groceries and other necessities to be partially covered when I see a doctor. Yes....parially covered.
I always seem to get blled for a large balance the insurance company won't cover. My policy costs $1300 a month for my family and BCBS can't cover a one time during the year visit of $800 for an MRI and a few doctor's visits for a broken foot? That's right! I pay half of $15600 a year for my family to be covered and I still get billed for the MRI and other aspects of my visits that were not "medically necessary" but were necessary for treatment....DUH!. CROOKS!!! Someone needs to do something because we can't live like this anymore.
I ned a medical bill bail out.

See my comment from April 5th...I'm also in your situation, but actually 8 months along. Here's something a little reassuring: I spoke to my doctor about what was going on, and she said that 9 times out of 10, these things work out. Middlesex would be losing a HUGE number of patients if an agreement is not made. She seemed to feel that Anthem basically sent that letter out to stress out patients to the point of putting pressure on Middlesex. I specifically asked her "if worse comes to worst and an agreement isn't made, what will happen? Will I have to go to another doctor and another hospital?" She responded "absolutely not," telling me that they don't want to lose their patients and send all these pregnant women to doctors they don't even know. In the mean time, I called Anthem as well, and no, they were not of very much help. The customer service rep basically took down my info to see if I met the guidelines for a "clinical transition," which would basically allow you to go to Middlesex for treatment for 30 days past the original effective date of May 1st (which in both of our cases, would do no good since I am due in the beginning of June). I told her "well really, that's not good enough...Yes it would be fine if I just HAPPENED to have the baby a week early, but whose to say that that will happen?" She said that there are other exceptions for cases like ours, where they may even extend it an additional week or two. I would try calling them again and bring that up. It's obviously not fair or reasonable to ask a woman who is pregnant (any ANY point in gestation, really) to switch doctors and go somewhere else. I'm keeping my fingers crossed that everything will work out.

Karen--
I saw your comment from April 5th and I feel a little better knowing there are others out there in our same situation. I also talked to my doctor and she seems to think that the two will most likely agree on something and I won't have anything to worry about. I did speak with a rep at Anthem and she told me (after informing me that this is a local issue, not an issue with the "national Anthem" account) that if they don't renew the contract and I decide to stick with my doctor and with Middlesex Hospital and pay the out of network fee, I can fill out "grievance" paperwork and claim continuity of care. She said that Anthem would have 60 days to give me an answer and that I would have a strong case for them to go back and cover the fees as if it was in network. However, she said this is a hit or miss and judging by the fact that Anthem is a huge company with lots of money, I don't think its worth it to risk. I am also keeping my fingers crossed! I like my doctor. I feel comfortable with her and I think it's extremely unreasonable to ask anyone in our situation to go find another doctor!!!!!!

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